Q:  Questions BP Dx of Many Females

I'll attempt to be as brief as possible, but it could be difficult.

My current girlfriend was diagnosed a long time ago as being Bipolar. My girlfriend before her said the same thing, as well as the 2 before them.  All are either taking the same meds as each other, or have tried the same meds before finding the correct combination for them.  Since I've discussed this with each one, I have started talking to other females I know about this "problem," and 1 by 1 each has told me they also have been diagnosed with some version of Bipolar. Since I started taking notes on this, I have found that every female I have personally discussed this with, including my 2 sisters and mother, roughly 8 personal friends, and all past girlfriends, supposedly are Bipolar.

My question is this: could many, if not all of these females I know be misdiagnosed? According to the statistics I've been able to find, less than 1% of the population (under 3 million Americans) has some form. So why does every female I know have it, but none of the males?

Additionally, the "symptoms" each has told me they had that led to their diagnosis seem to be just normal life. Everyone has problems, and some people don't deal with  them well, while others do. I found that I also experienced the same symptoms, and when I've taken the questionnaires associated with Bipolar, I seem to also have it.  However, I figured out a long time ago how to control my reactions to situations. I now no longer let a periodic depression take me out of society, nor do I let any anxiety or panic attacks cause me to stop functioning.  All have been past problems  for me, but I conquered them without meds, and I haven't seen a Psychiatrist or Psychologist since I was about 21.

It just seems to me that most people who have this disorder might have behavioral problems that they need to work on, or is that what Bipolar Disorder is-- a behavioral problem? I don't want to be insensitive and don't feel that I have been yet towards anyone, but inside I am starting to feel resentment and maybe some people are just being lazy in their attempts to modify their reactions to problems.
 

Dear Matt -- 
You raise an important issue.  For starters, I suppose you could go through your girlfriends and friends and try to complete a Mood Disorders Questionnaire on each them from memory, to try to cross-check the diagnosis.  Of course if they were being treated for the symptoms, you shouldn't have been able to detect them, so the test would come out "negative".   

The 1% figure refers in most cases to Bipolar I, and what you've been encountering (if it was accurate) is probably Bipolar II.  Recent estimates by some of the more aggressive "diagnosers" of bipolar disorder say at least a third of all depression cases have some "bipolarity" to them, and depression affects about 5% of the population -- but even still, it wouldn't account for knowing no men with it, and all these women.  Factor in depression being twice as common in women than in men, it still wouldn't account for your experience.  

Factor in the frequency of sexual abuse of women somewhere between 15 and 30% in most reports, and that might shift things a bit, as sexual abuse is one of the stressors that can trigger a genetic risk for bipolar disorder.  It can also cause a post-traumatic stress syndrome (think rape) that looks a lot like bipolar disorder in some cases.  And few of your men friends would have a history of sexual abuse, certainly nothing like 30%..  

But still, your question is still a good one even taking all that into account.  Were some or many of these women misdiagnosed?  (then we'll come to the question of whether there's some ulterior motive for looking for and accepting such a diagnosis)  Obviously I can't comment on the accuracy of their individual diagnoses.  

I have wondered "aloud" as to whether there isn't some sort of parallel, or overlap, or maybe even more direct relationship, between PMS and bipolar symptoms -- i.e. PMS as similar but less severe and related only to the last phase of the menstrual cycle (see Hormones and Mood, the Working Model part below the figure).

There is a bit of a trend right now toward Bipolar II as the "in" diagnosis (in part because it has been so overlooked, not officially recognized, for so long) -- but may I caution you, this has not been sufficient among people I see to account for more than 1 in a hundred or so of the people to whom I give this diagnosis.   That is, only maybe 1 in 100 comes in saying "I think I might have bipolar II".  Usually it's "I'm having a terrible time with depression" and then we hear about anger, and mood swings, and difficulty sleeping, and all the rest you may have read about (here's my version of Bipolar II, if you want a broad view with some references). 

Now, are some people using these diagnoses as some sort of excuse?  instead of something more like what you've done?  perhaps somewhat; hard to say without knowing some more details, and that would be the trickiest angle of your question to address (the "just being lazy" part).  

But one more thought.  Biologists use the term "non-assortative mating" to refer to mate choices that are biased, i.e. not "assortative", not truly random.  Perhaps at least a portion of your experience is accounted for in this way.  If, as you say, you personally have bipolar traits, it could be that you find attractive -- for friends, as well as girlfriends -- women who have some of these traits also (although this would apply to men as well, so there ought to be a guy in there too who has bipolar traits, by this analysis alone).  Thus you might be getting a very non-random sample of the general population amongst your friends.  Maybe. 

Dr. Phelps

Published June, 2003